Another in a mini-series on values and actions, stimulated by reading about ACT, or Acceptance and Commitment Therapy.
For many of the people I work with, remaining committed to a set of actions that lead towards a desired goal seems to be a very challenging thing. Often, at a one-month review, I find one group of people who are moving forward consistently, another group who are simply going through the motions because someone else is ‘making’ them do it (eg case managers or family members), and by far the largest group, those who are saying ‘I’d be on my way but …’ – and the ‘but’ can be so many things:
- my case manager hasn’t fronted up with the money for the course I wanted, so I can’t start my return to work plan
- I can’t afford to pay for a gym membership, so I haven’t started my exercise plan
- my GP hasn’t reviewed my medications, so I can’t start my sleep programme
This group of people have had loads of enthusiasm, but somehow can’t see a way to put little steps in place that lead towards achieving the valued goal. I’m not sure of all the reasons – and I know that the reasons that are often given are only part of the picture because often people aren’t aware of their own reasons for not moving forward.
It’s this area of pain management that I think often gets forgotten in the push to ensure people have ‘skills’, ‘knowledge’, ‘support’ – that it’s a process of moving towards the goal. Having knowledge, having skills, and even having support simply isn’t sufficient to help someone take action.
Perhaps it’s a case of the person not yet being in the ‘action’ phase of the stages of change… perhaps it’s lack of confidence to achieve change…perhaps it’s because making change raises the spectre of experiencing uncomfortable emotions and thoughts (and as therapists we may not have helped the person become willing to accept these feelings as part of change)…
There are so many reasons I can’t list them all here.
I do know that simply providing information, or training in skills isn’t enough. Perhaps it’s partly about helping the person remain aware of the values their actions are embodying. Maybe it’s about helping the person feel OK about experiencing uncomfortable feelings (including fluctuations in pain). It may also be about ensuring the person experiences some of these things before the end of therapy – and helping them develop effective action plans that they have used more than once before our interaction ends.
This implies that we may need to engineer some opportunities to fail during therapy to help the person develop confidence to persist. It also suggests we might need to gradually taper the sessions we have so the person has time to work independently, and experience the progress and plateau’s that are part of taking action. And I think it also means we need to help the person really become alive to the meaning of their actions – what values are being lived by taking these steps towards a goal? Maybe we assume that the goals, because they’ve been chosen by the person (hopefully!), are sufficiently tied in with values – but maybe the goals are more about pleasing others (or even ourselves) than strongly identified with what the person values.
More on this tomorrow – and some references I hope to help expand on what I’m exploring here.